Study design
This is a cross-sectional analysis of the Lawrence Health and Well Being Study of Latino adults in the city of Lawrence, Massachusetts. Participants were patients at the Greater Lawrence Family Health Center (GLFHC), a federally qualified community health center that sees an estimated 80–85 % of the Lawrence area Latino population. Proportional sampling within specified age (21–34, 35–54, 55–85) and gender strata, using electronic patient records, randomly selected potential research participants who met inclusion and exclusion criteria. Inclusion criteria included, being of Latino or Hispanic ethnicity, Spanish or English speaking, and between 21 and 85 years of age. Ethnicity was self-reported, and we included individuals who perceived themselves at Hispanic or Latinos. Of note, a majority of the sample (73.4 %) reported being of Dominican ethnicity. Individuals were excluded if they were unable or unwilling to give informed consent, planned to move out of the area within the original study period, had cognitive impairments that precluded participation (i.e. answering verbally administered questions), and/or had a life expectancy of less than 5 years, as determined by their primary care provider (PCP). Letters signed by the chief medical officer that included a description of the study (in Spanish and English) were sent to eligible participants. The letters stated that a study coordinator would call patients to provide additional information about the study, assess eligibility, and inquire about interest in participating. A toll-free number was provided for patients to call if they did not wish to participate. Bilingual/bicultural coordinators contacted patients and patients who were interested and eligible were invited to participate. Each individual assessment took place at a community site with easy access to participants (the Lawrence Senior center), were administered verbally by trained staff, and lasted approximately 2.5–3 h.
Measures
Demographic characteristics
Individuals self-reported their gender, age, employment, education, and smoking status. Smoking status was assessed by asking individuals if they currently smoke every day, some days, or not at all. BMI was calculated from height and weight measured by study staff.
Physical activity
Physical activity was measured using the Women’s Health Initiative (WHI) Brief Physical Activity Questionnaire [30]. This 9-item multiple choice questionnaire assessed leisure-time walking as well as mild, moderate, and vigorous physical activity. For each activity category, individuals were asked to report frequency (“How many days of the week do you usually do mild exercise?”) and duration (“When you exercise like this, how long do you do it for?”). Frequency was assessed with a 5-point scale ranging from “never” to “7 + times” per week for walking, and ranging from “1 day” to “5 or more days” for mild, moderate, and vigorous exercise. Duration was assessed on a 4-point scale ranging from “less than 20 min” to “1 h or more”. Physical activity per week was obtained by multiplying frequency and duration multiple choice categories. Categories with a range (i.e. 20–39 min) were recoded to their midpoint values [30]. Due to the high proportion of individuals participating in 0 min of physical activity per week, the data was further coded to categorize individuals as engaging in 0 min of physical activity per week (inactive), >0–150 min of physical activity per week (not meeting guidelines), or >150 min per week (meeting guidelines). This questionnaire has been validated with adequate sensitivity and measurement bias compared to widely accepted physical activity measures [30].
Sedentary behavior
Sedentary behavior was assessed via The Sedentary Behavior Questionnaire [31]. Using this 22-item measure, individuals reported the amount of time they spent engaging in a set of sedentary behaviors on a scale 0 (none) to 9 (6 or more hours). Sedentary behaviors include sitting while: watching television, playing computer/video games, using the computer or Internet, listening to music, talking on the phone, doing paperwork or office work, reading, playing a musical instrument, doing arts and crafts, and driving or riding in a car, bus, or train. We modified the original scale to add additional sedentary activities: computer time and texting while sitting. For each behavior, individuals report average duration per day on weekdays and weekend days separately. Total sedentary time was calculated by converting scale ratings to number of hours. Weekday hours were multiplied by 5, weekend hours were multiplied by 2, and sums for total hours/week were averaged across 7 days. This questionnaire has a high intraclass correlation via test-retest reliability, and has modest associations with objective measures of sitting [31].
Environment
The Mujahid Neighborhood Health Questionnaire measured seven social and physical neighborhood environment features that may be associated with CVD risk, namely violence, safety, aesthetic quality, walking environment, availability of healthy foods, social cohesion, and activities with neighbors [11]. For safety, aesthetic quality, walking environment, availability of healthy foods, and social cohesion, responses were given on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree”. Scales for violence and activities with neighbors ranged from 1 (often) to 4 (never). Scores were estimated by averaging all items within the scale. Scores were reversed in order to improve clarity of interpretation so that higher scores suggested higher neighborhood violence, safety, aesthetic quality, walkability, available healthy foods, social cohesion, and activities with neighbors.. This has shown to be a valid and reliable measure, with Cronbach’s alphas ranging from 0.73 to 0.83 and test-retest reliabilities of 0.6 to 0.88, and reliabilities of greater than 0.64 and 0.78 for objectively measured census tracts and census clusters, respectively [11].
Statistical analysis
SPSS IBM Statistics (version 23) software was used for data analysis. Means, standard deviations, and frequencies were calculated for demographic variables as well as neighborhood variables, physical activity, and sedentary behavior. Multinomial logistic regression assessed the association of perceived neighborhood violence, safety, aesthetic quality, walking environment, availability of healthy foods, social cohesion, and activities with neighbors with level of physical activity engagement. Multiple linear regression models evaluated the extent to which perceived neighborhood violence, safety, aesthetic quality, walking environment, availability of healthy foods, social cohesion, and activities with neighbors were associated with total time spent in sedentary behavior. Perceived neighborhood variables were examined separately due to collinearity between subscales, as suggested by the survey developers [32]. Each perceived neighborhood variables was entered first into an unadjusted model for each outcome, and then a model adjusted for age, gender, BMI, education level, and smoking.